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What is Type 2 Diabetes (T2D)?
T2D, also known as diabetes mellitus type 2 or adult-onset diabetes, is a long-term (chronic) metabolic disorder. Metabolism is a measure of all the reactions in your body needed for you to carry on healthy living. Metabolism is most commonly associated with the breakdown of food for energy, and the use of that energy to grow, repair and maintain the human body. With T2D, your body has a specific problem with how it breaks down food and how it uses it for energy and storage.
One of the most important compounds that regulates energy utilization and storage in the body is insulin. It is a hormone made in the pancreas that controls the body’s main energy source, glucose or more simply, sugar. Type II diabetes is a disorder that results from the lack of insulin in your blood or when your body has a problem using the insulin it produces, which is called insulin resistance. As a result, sugar levels build up in your blood instead of getting used for energy. Some characteristic signs of type-2 diabetes is having high blood sugar levels, insulin resistance, and low levels of insulin. There are two main types of diabetes: type 1 and type 2. Nearly 90% of all people with diabetes have T2D, while the rest have type 1 diabetes mellitus and gestational diabetes.
The rates of T2D have been increasing dramatically since the 1960s alongside obesity rates. In 2015, there were approximately 392 million people around the world with the type 2 diabetes compared to around 30 million in 1985. T2D typically begins in middle or older age, although the rates are increasing in young people as childhood obesity increases as well. People that have been diagnosed with T2D have a shorter life span expectancy by about 10 years than those that do not have diabetes type two.
Although currently there is no cure for diabetes type 2, you can manage your condition by eating healthy, getting regular exercise and maintaining a healthy weight. If exercise and diet are not enough to manage your symptoms and blood sugar levels, you also may need diabetic medications or insulin therapy.
Signs and Symptoms
The classic symptoms of T2D are frequent urination, increased thirst, weight loss and increased hunger. Other symptoms that are common include itchiness,blurred vision, recurrent vaginal infections, peripheral neuropathy (nerve damage), sores that don’t heal, and fatigue. Often these symptoms come on gradually, and over long periods of time. If left untreated the long-term complications from having T2D and the associated high blood sugar levels includes heart disease, stroke, diabetic retinopathy (damage to the retina of the eye) which may result in kidney failure, blindness, and reduced blood flow to the limbs which may lead to amputations. Other complications due to diabetes may be the sudden onset of hyperosmolar hyperglycemic state, which is severe dehydration resulting from high blood sugar, and less commonly diabetic ketoacidosis, which is when you have high blood sugar, low blood pH, and ketoacids in either your blood or your urine. Many people don’t show any obvious symptoms for years, and are only diagnosed by routine blood testing during a regular check up at their doctor.
The main causes of T2D are lack of exercise, obesity, and consuming too much food. Although some people have a greater genetic risk than others. If one identical twin has diabetes, the chance of the other twin (with the exact same genetics) developing diabetes within their lifetime is greater than 90%, while the rate for non-identical siblings (with similar genetics) is 25–50%.
T2D is more likely to occur in those who:
- are over 40 years old
- are overweight, or obese
- developed gestational diabetes during pregnancy
- have a family history of diabetes
- have given birth to a baby that weighed more than 9 lbs (4 kg)
- have high blood pressure (140 over 90 or higher)
- have high cholesterol*
- have impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)
- are of Aboriginal, Hispanic, Asian, South Asian, or South African descent
* Cholesterol levels can be measured in milligrams (mg) of cholesterol per deciliter (dL) of blood, or like in Canada and many European countries, in millimoles per liter (mmol/L).
Type 2 diabetes is preventable for the large part by exercising regularly, having a healthy diet and maintaining a normal weight. Treatment typically involves increased dietary changes and exercise, and if blood sugar levels are still not sufficiently controlled, the diabetic medication Metformin is usually prescribed. Many people may eventually be also required to receive insulin injections.
Proper nutrition and regular exercise can significantly delay or even prevent the onset of T2D. Some studies have shown that intensive lifestyle measures may reduce your overall risk by over half. The benefits of exercise occur regardless of the your initial weight or your subsequent weight loss. Specifically, high levels of physical activity have been shown to reduce your risk of diabetes by about 30%. When diet and exercise have not worked, bariatric surgery often can improve diabetic complications in those people who are obese.
Overall, even with a diagnosis of T2D, you can live a long and healthy life by maintaining your blood sugar levels. Some tips on keeping your blood sugar levels healthy are:
- Enjoying healthy snacks and meals
- Regular physical exercise
- Monitoring your blood sugar levels
- Having a healthy body weight or a healthy target weight
- Making sure to take your diabetes medications exactly as your doctor prescribes
- Keeping stress levels low
Classification of Diabetes Drugs
Sulfonylureas (Sulfa, Sulfonamide)
Sulfonylureas are a large family of commonly-prescribed hypoglycemic (blood sugar lowering) medications. They reduce blood sugar levels by stimulating beta cells in the pancreas to secrete insulin. Some examples of sulfonylurea medicatiosn are Amaryl (glimepiride), Diabinese (chlorpropamide), Glyburide or Glibenclamide, and Tolbutamide.
GLP-1 agonists or analogues
(Glucagon-like peptide-1 receptor agonists also known as GLP-1 receptor agonists or incretin mimetics)
GLP-1 agonists are drugs used to treat T2D by binding to receptors usually bound by glucagon. In the presence of high blood sugar levels these drugs stimulate the release of insulin from the pancreas. They have the advantage over older antidiabetic medicines by having a lower risk of causing low blood sugar levels (hypoglycemia). Some examples of GLP-1 agonists are Saxenda (liraglutide), Victoza (iraglutide), and Trulicity (dulaglutide).
DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors), or gliptins
DPP-4 inhibitors are oral antidiabetic medications which reduce glucagon and blood sugar levels, while regulating insulin levels, especially in response to a meal. They prevent the breakdown of hormones involved with appetite, digestion and insulin regulation. They allow for more insulin to be released from the pancreas while slowing glucagon release, which prevents blood sugar level increases. Some examples of DPP-4 inhibitors are Januvia (sitagliptin), Tradjenta (linagliptin), Komboglyze (saxagliptin), and Onglyza (saxagliptin).
Meglitinides, or glinides, are another family of diabetic drugs. They have a similar mode of action as the Sulfonylurea family of diabetic drugs. They help your body release more insulin from pancreatic beta cells when your blood sugar levels get too high. An example of a Meglitinide is Prandin (Repaglinide).
Thiazolidinediones also known as glitazones, are a group of insulin-sensitizing medications used for the treatment of T2D. They control the genes involved in the regulation of food breakdown in the body. Primarily, they reduce the level of fat in the blood making cells use up more sugar from the blood thereby lowering blood sugar levels. They also reduce insulin resistance (a condition in which the cells in your body fail to respond normally to insulin), decrease gluconeogenesis (the production of sugar from food), and reduce blood sugar levels. Some examples of Thiazolidinediones are Avandia (rosiglitazone) and Actos (pioglitazone).
Biguanides are a large group of compounds, used for many different purposes, some of which are antidiabetic drugs. Metformin, one of the most common antidiabetic drugs, belongs to this class of medication. Its main effect is to decrease liver sugar production, but it also increases insulin sensitivity, which increases your body’s ability to absorb and process sugar.
Sodium-glucose co-transporter 2 (SGLT2)
Sodium-glucose co transporters are responsible for approximately 90% of the kidney’s reabsorption of sugar into the kidneys. SGLT2s or Gliflozins block this ability, preventing this absorption by the kidneys, which causes the sugar in your blood to be eliminated through your urine. The drug also increases your urination rate, thus clearing even more blood sugar from your body. Some examples of Gliflozins are Farxiga (dapagliflozin), Invokana (canagliflozin) and Jardiance (empagliflozin).
Alpha-glucosidase inhibitors are oral anti-diabetic medications used for the treatment of type 2 diabetes. They are themselves carbohydrates, and they act by inhibiting digestive enzymes, thus preventing the breakdown of complex carbohydrates into glucose. Because of this, they must be taken at the start of main meals to have their optimal effect. The therapeutic effects of lowering blood sugar levels following meals is highly dependent on the amount of complex carbohydrates eaten during the meal. Alpha-glucosidase inhibitors include Precose (acarbose) and Voglib (Voglibose).
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